T h e P h y s ic a l E x a m in a t io n o f A b d o m e n

2 n d A f f i l ia t e d H o s p i t a l C h in a M e d ic a l U n iv e r s i t y

内 科 郑 长 青

4. Palpation of massesthe masses of abdomen may be caused by enlarged organ ectopic organ cyst carcinoma inflammatory tissues enlarged lymphnode

(1)Normal masses of abdomen tendon of abdominal rectus lumber vertebral body sacral promontory sigmoid colon transverse colon cecum

(2).Abnormal mass of abdomen when you palpate the mass of abdomen you should describe the location size contour consistency tenderness pulsation mobility

The location of mass The mass usually originate from located organ, where you find a mass where the organ has lesion. If the location of mass is variable, the mass may originate from omentum, mesentery, or with stalk.

big mass without intestinal obstruction, the mass originate from mesentery peritoneum omentum postperitoneum

The size of mass The mass should be measured with a ruler to see how big it is, but sometimes the measurement is difficult, such as deep mass, small mass so you can estimate the size of mass, comparing with something like peanut, bean, egg, fist, baby`s head and so on.

Big mass usually indicate cyst such as ovarian cyst, hepatic cyst or polycystic kidney. Intestinal tumor usually accompanied with intestinal obstruction. Mass with variable size indicates spasm of intestinal segment.

The contour of mass ※ the outline of mass is clear or

not ※ the surface is smooth or not ※ the margin is sharp or blunt ※ round and smooth mass indicate a cyst

※ Irregular, nodular, hard mass indicate malignant tumor

※ A soft cystic mass in right hypochondrial region indicate distended gallbladder ※ A mass with notch in left upper quadrant indicate splenomegaly

The consistency of mass ※ soft mass cyst, abscess ※ middle hard inflammatory

mass ※ hard tumor

the tenderness of mass ※ severe tenderness inflammatory mass ※ light tenderness tumor

The pulsation of mass ※ abdominal aneurysm or a mass next to the aorta ※ enlargement of liver with pulsation tricuspid valve incompetence

The mobility of mass ※ a mass move with respiration

it maybe from liver, spleen, stomach, kidney, gallbladder or transverse colon ※ a mass can be moved with hand it may be from stomach, intestine or mesentery

※ A mass can be moved easily and widely it may be from a tumor with a stalk wandering kidney wandering spleen

※ A mass can not be moved it may be from postperitoneal or inflammatory mass

5. Fluid wave thrill with the patient in supine position, the examiner’s left hand is placed on the patient’ s right flank, an assistant (another person) places one hand on the middle of the abdomen to prevent the transmission of any wave through the tissues of the abdominal wall

The examiners’s right hand then lightly taps the left flank of the patient, in the presence of a significant amount of ascites, a wave will be transmitted through the fluid to the examiner’s left hand as a sharp impulse.

6. Succussion splash

Succussion splashthis examining method can check for retention of gastric fluid. If succussion splash is positive after meal 6-8 hours indicating pyloric obstruction

Percussion

Percussion can check for the presence of abdominaldistention, tumor, fluid, enlargement of viscera.percussion tone of abdomen liver spleen dullness flatness remains tympany

Percussion of liver --upper margin

Percussion of liver --lower margin

normal liver upper limit 5th intercostal space

lower border --costal margin diameter of dullness 9-11cm enlargement of liver dullness hepatitis, hepatic carcinoma hepatic cyst hepatic abscess hepatic engorgement

Decreased liver dullness cirrhosis of liver, hepatonecrosis absence of liver dullness perforation of hollow viscus interposition of hepatic flexure of

colon percussive pain of liver hepatitis hepatic abscess percussive pain of gallbladder cholecystitis

Percussion of spleennormal left midaxillary line 9th –11th intercostal space width 4-7cm enlargement of splenic dullness: splenomegaly

traube area tympanitic area of stomach

Percussion of kidney percusive pain of kidney nephritis glomerulonephritis pyelothiasis perirenal abscess

percussion of bladder distended bladder dullness disappear after urination

Percussion of ascites shifting dullness >1000ml elbow-knee position check for small amount ascites

differentiate massive ovariocyst from ascites ovariocyst dullness locate center abdomen no shifting dullness ruler pressing test (＋ )

differentiate massive ovariocyst from ascites

Auscultation

bowel sound normal 4-5times /min increased >10times acute intestinitis, loud high-pitched tinkling quality: intestinal obstruction decreased or disappeared: acute peritonitis, intestinal paralysis, electrolyte disorder

vascular bruitsystolic bruit partial occlusion of renal artery above umbilicus left or right side hepatic cancer lesion areaabdominal aneurysm or partial

occlusion of abdominal aorta

Vein bruit periumbilicus, upper abdomen or over the liver: continuous humming sound, seen in portal hypertension caused by cirrhosis of liver

Friction rubover the spleen or over the liver perisplenitis caused by spleen infarction perihepatitis

Scratch sound exploration of hepatic lower edge auscultary percussion auscultary scratch exploration of small quantity of ascites about 120 ml

The main symptoms and signs of abdominal co

mmon diseases

Gastric and Duodenal Ulcer

In etiology, gastric and duodenal ulcer always have relation to hydrochloric acid and pepsin, so they are also called Peptic Ulcer

Symptoms

Chronic pigastric pain is main symptom of peptic ulcer

The pain has following features

1 Location and Extent

The pain from gastric ulcer is just under xiphoid or left, but duodenal ulcer is located in the middle of epigastrium or right.

The extent of the pain is just like a palm size.

2 The character of pain

The character of pain is frequently described as burning, blunt or hunger pain.

The pain is continuous, often lasting 1-4h.

3 Chronicity and Recurrence of

peptic ulcer, some patients with peptic ulcer are reported annual recurrence of pain during particular seasons, such as spring or autumn, especially early spring or late autumn

4 The rhythmicity of pain

The pain from peptic ulcer has certain relation to meals The pain from gastric ulcer often occurs at 0.5-2h after meals, disppear until next meal. The rhythmicity of pain is meal-pain-remission

The pain from duodenal ulcer often occurs at 2-3h after meal, until next meal, so the rhythmicity of pain is pain-meal-remission, so called hunger pain and the pain usually occurs at bed time or midnight, so called nocturnal pain.

Other symptoms in addition to pain, the patient with peptic ulcer may have other symptoms such as nausea, vomiting, heartburn, weight loss and so on.

Signs During remission, on signs can be found, but in active peptic ulcer, most frequently there is a epigastric tenderness, the point of tenderness is just the same as the location of peptic ulcer.

Complications Bleeding Perforation Obstruction Gastric cancer